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Candidiasis

Introduction

What should I know about Candidiasis?

For many years, fungal infections were considered as "nuisance diseases" such as athletes foot or vaginal yeast infections. However, advances in medical technology, including organ and bone marrow transplants, chemotherapy, and the increased use of antibiotics have added to the increase in fungal infections.

The word "Candida" refers to a yeast that is a normal organism on the skin, female genital tract, and the entire gastrointestinal (GI) tract of humans. (1) Just because it is in these areas does not mean that there is a disease present. "Candidiasis" is a word that describes a fungal infection in the mouth, esophagus, or vaginal area. It can also include general infections in single or multiple organs including the eye, brain, heart, kidney, skin, bone, and joints.

Clearly, the patient with a poor immune defense system is at greatest risk for infection by Candida. (2) , (3) The oral cavity and GI tract are the common entry points for the organism to invade the body causing an infection. These infections are divided into oropharyngeal candidiasis (thrush), esophageal candidiasis, GI candidiasis, and vaginal candidiasis. Also included are patients who have a syndrome known as chronic mucotaneous candidiasis. These patients are plagued by chronic or returning infections of the skin, nails, and mucous membranes. Most of these patients have problems with their immune systems.

Generally, infections are usually treated with antifungal medications; however, infections commonly return when therapy is stopped.

Risk factors for developing candidiasis include:

    prior therapy with antibiotics; recent surgery; extensive burns; having bacterial infections at the same time; nutrition by IV only (called total parenteral nutrition – TPN).

Oral candidiasis is generally not considered life threatening. However, it does cause discomfort, and in patients with a poor immune system, can spread to the esophagus, causing ulcers and tears in the mucous lining. A variety of factors are generally necessary for the development of oral candidiasis, including age, immune system deficiencies (including malignancies, diabetes mellitus, and AIDS), nutritional deficiencies, radiation therapy, anti-cancer drugs, and the use of antibiotics or steroid drugs.

Within the urinary tract, the most common Candida infection (Candida cystitis) often follows therapy with antibiotics, if there is a catheter in the bladder, or when there is a kidney abscess. There are usually no symptoms and the infection heals without the use of antifungal drugs. It is often difficult to diagnose this condition due to the normal presence of Candida in the urinary tract.

Statistic

National Institute of Allergy and Infectious Diseases (NIAID)-2000.

    Doctors estimate that approximately 75 percent of all women will experience at least one symptomatic yeast infection during their lifetimes.

Centers for Disease Control (CDC), Division of Bacterial and Mycotic Disease, 2005

    An estimated 8 cases per 100,000 persons within the general population will contract some form of candidiasis. Candidiasis represents the fourth most common cause of nosocomial bloodstream infections. There is nearly a 50% mortality rate of those with bloodstream and disseminated Candidasis.

Signs and Symptoms

The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.

Oral candidiasis (thrush) is characterized by the presence of creamy white patches on the tongue and lining of the cheeks, which generally leave a painful, raw surface when scraped. The diagnosis is based upon clinical appearance and the scraping of the sores to test for the presence of a fungus. Candida esophagitis is most often associated with certain treatments for cancer and AIDS patients, although it occasionally occurs in patients with no known risk factors. Symptoms include pain with swallowing, difficulty swallowing, a feeling of a closing throat, and occasionally chest pain beneath the breast bone or sternum. Sometimes, patients have no symptoms until bleeding or obstruction occurs. A barium swallow can often reveal a characteristic appearance, but a definite diagnosis is made by scraping the sore or growth during an endoscopic procedure.

A thick, curd-like vaginal discharge and intense itching characterize vaginal candidiasis. It is a common infection in women and is diagnosed by the presence of specific cell types contained in the vaginal discharge.

Candida infections can exist throughout the body. Three distinct presentations of disseminated C. albicans have been recognized. In the first, and most common type, patients have a fever, rapid heart rate, rapid breathing, and occasionally chills or low blood pressure. The symptoms are generally identical to other whole body infections. The second group of patients develops occasional fevers and is ill only when they have a fever. A third group of patients has a progressive deterioration of their condition with or without fever. (4) In many patients, multiple micro- and macro-abscesses or areas of infection are formed. Infections of the liver and spleen are becoming recognized as a particularly common and difficult to treat site of infection. It characteristically occurs in patients who are undergoing chemotherapy for leukemia or lymphoma and may result in the patient’s death despite aggressive treatment.

Oral Candidiasis (thrush)
  • Red, sore lining of the mouth and tongue
  • White spots or patches on tongue or cheeks
Candida infection of the esophagus (esophagitis)
  • Difficulty swallowing
  • Painful swallowing
  • Feeling of a lump in the throat
  • Occasionally a feeling of pain behind the breast bone (sternum)
  • Sometimes no symptoms occur until bleeding or complete closing off (obstruction) of the esophagus occurs
  • Is often seen in patients receiving treatment for cancer or AIDS
Vaginal Candidiasis (yeast infection)
  • Extreme itching of the vagina or vulva
  • Thick, white vaginal discharge, often cottage cheese-like
  • Redness of the vulva
  • Sometimes there will be irritation when urinating
Disseminated Candidiasis (infection spread through other organs in the body)
  • These are very severe infections that require hospitalization, and may be life threatening
  • Fever
  • Rapid heart rate
  • Rapid breathing
  • Occasionally chills
  • Low blood pressure
  • Not all patients show the same symptoms
  • Often occurs in patients with leukemia or lymphoma who are receiving chemotherapy
Other
  • Candida may be seen as a skin rash (or diaper rash in infants)
  • Itchy red patches with small red bumps
  • May occasionally occur in men as swelling and redness on the penis and foreskin

Treatment Options

Conventional

Topical therapy with a variety of antifungal agents may be used in the treatment of oral candidiasis. The drugs nystatin (in a liquid suspension form) and clotrimazole (in a lozenge form) are usually used. Dosage and how many times the drug is used per day may be different for each patient. For some patients, the use of these topical antifungal drugs is very effective. Other patients have found topical therapy to be ineffective.

The most common dosage for nystatin is to "swish in the mouth and swallow" the prescribed dosage (from one-half to one and a half million units) four to six times a day. AIDS patients do not handle nystatin therapy very well, and it frequently does not work for the prevention or treatment of thrush. Topical agents may not be enough treatment for the AIDS patient. Other drugs used in oral candidiasis include fluconazole, ketoconazole, itraconazole, and occasionally amphotericin-B oral solution. Dosages have a wide range depending on the population being treated, with higher doses often being used in AIDS patients or cancer patients.

For esophageal candidiasis, drugs used include fluconazole or ketoconazole by mouth, or amphotericin B given intravenously (IV).

To treat vaginal candidiasis, a topical drug such as miconazole or clotrimazole may be used vaginally daily for 1-3 days, or fluconazole can be used by mouth for one dose, or ketoconazole can be used. To keep infections from coming back, a daily dose of fluconazole is recommended.

For Candida infections of the urinary tract, an amphotericin B bladder wash can be used, where a solution is placed into the bladder with a catheter.

Nutritional Suplementation


Lactobacillus acidophilus

Lactobacillus acidophilus bacteria slow down the growth of the Candida organism. Some reports say that eating products containing lactobacillus acidophilus can be helpful in the prevention and treatment of intestinal and vaginal candidiasis. (5) , (6) , (7) , (8)

Herbal Suplementation


Cat's Claw

Cat’s claw has been used as a medicine possibly as far back as the Incan civilization. Cat’s claw may affect the immune system and act as an antioxidant. (9) Cat’s claw may reduce inflammation and swelling. (10)

Colon toxicity has been somewhat ignored in Western medicine. It is now becoming apparent that bowel hygiene and a proper balance of intestinal bacteria are essential to good health. If the colon flora is out of balance (dysbiosis) or if food is not being properly digested and absorbed, toxic substances may be produced. Cat’s claw may be able to soothe irritated and inflamed tissues and help eliminate harmful bacteria from the gastrointestinal (GI) tract. (11)

Cat’s claw root bark apparently contains the health promoting ingredients.


Olive Leaf

Olive leaf extract may be effective against a wide variety of harmful bacteria that can cause intestinal or respiratory tract infections in humans. (12) The active ingredient in olive leaf is oleuropein. (13) , (14)

Olive leaf extract may also be useful against viruses (antiviral). (15) , (16) As an antifungal and antiviral agent, olive leaf extract is used to maintain healthy bowel bacteria. (17)


Garlic

Garlic is known for its benefits in cardiovascular health. (18) , (19) There are several important actions due to the sulfur-containing compounds in garlic. These compounds (allicin and alliin) are reported to have anti-infective actions against bacteria and fungi. (20) , (21)

Processing of the garlic product is an important fact to keep in mind with garlic supplements. Changes can occur in the active ingredients when cooked or processed, which can make the garlic product ineffective. Garlic products with a protective (enteric) coating may be a better choice because stomach acid may inactivate the product.


Tea Tree Oil

Melaleuca alternifolia, or tea tree, is a small tree native to only one area of the world: the northeast coastal region of New South Wales, Australia. The leaves of tea tree were used by the early settlers of Australia to make tea, hence the name "tea tree". An oil from the leaves has been used as a medicine for centuries and was first reported to the western world by the crew of Captain James Cook's expeditions in the 1700's. The plant gained fame because of claims of its ability to treat various problems including skin ailments, cuts, and burns.

During World War II, tea tree oil was given to soldiers worldwide for use as a disinfectant. The Australian army actually exempted leaf cutters from military service in order to maintain production of the tea tree oil. (22) Also during World War II, tea tree oil was routinely used in machine "cutting" oils in Australian ammunition factories. The oil was reported to decrease the number of infections from abrasions on the hands of factory workers caused by metal filings. The production of tea tree oil in Australia was considered an "essential" industry during the war.

Tea tree oil has historically been used in many conditions including the treatment of acne, athlete’s foot and ringworm, skin and vaginal infections, infections of the nail bed, thrush, tonsillitis, and other topical infectious conditions. Also, as early as 1930, the antiseptic properties of the plant were recognized by the Australian dental profession. (23)

The use of tea tree oil is based on its antiseptic and antifungal properties. This claim is supported by its usefulness against a wide range of organisms, (24) , (25) including bacteria found to cause hard to treat hospital acquired infections, (26) topical Candida infections, (27) and tinea pedis (athlete’s foot). (28)


Grapefruit Seed

Grapefruit seed extract has been reported to have antibacterial action. (29) Grapefruit seed extract is also used to restore the balance of normal bacterial flora in the gastrointestinal tract, including Candida. In one study, an improvement in constipation, flatulence (gas), abdominal discomfort, and night rest were noticed after four weeks of therapy. (30)


Larch Arabinogalactan

Larch arabinogalactan (LA) is receiving increased attention as an agent that can improve the immune system. It may also be effective against many bacteria, viruses, and fungi (including Candida). (31) LA may be a good therapeutic choice for individuals with immune system problems, including colds and influenza, chronic fatigue, and viral hepatitis among others.

References

  1. Carver, PL. Invasive Fungal infections. In: DiPiro JT. et al eds. Pharmacotherapy, a Pathophysiologic Approach. 4th ed. Appleton & Lange. Stamford CT. 1999:1839-1856.
  2. View Abstract: Meunier-Carpentier F, Kiehn TE, Armstrong D. Fungemia in the immunocompromised host. Changing patterns, antigenemia, high mortality. Am J Med. Sep1981;71(3):363-70.
  3. View Abstract: Hay RJ. The management of superficial candidiasis. J Am Acad Dermatol. Jun1999;40(6 Pt 2):S35-42.
  4. Edwards JE. Candida species. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 4th ed. New York. Churchill Livingstone Inc. 1995:2289-306.
  5. View Abstract: Elmer GW, et al. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA. Mar1996;275(11):870-6.
  6. View Abstract: Hilton E, et al. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med. Mar1992;116(5):353-7.
  7. View Abstract: Fitzsimmons N, Berry DR. Inhibition of Candida albicans by Lactobacillus acidophilus: evidence for the involvement of a peroxidase system. Microbios. 1994;80(323):125-33.
  8. View Abstract: Jack M, et al. Evidence for the involvement of thiocyanate in the inhibition of Candida albicans by Lactobacillus acidophilus. Microbios. 1990;62(250):37-46.
  9. View Abstract: Aquino R, et al. Plant Metabolites. Structure and in Vitro Antiviral Activity of Quinovic Acid Glycosides from Uncaria tomentosa and Guettarda platypoda. J Nat Prod. 1989;52(4):679-85.
  10. View Abstract: Aquino R, et al. Plant Metabolites. New Compounds and Anti-inflammatory Activity of Uncaria tomentosa. J Nat Prod. 1991;54(2):453-59.
  11. View Abstract: Sandoval-Chacon M. Antiinflammatory actions of cat's claw: the role of NF-kappaB. Aliment Pharmacol Ther. Dec1998;12(12):1279-89.
  12. View Abstract: Bisignano G, et al. On the in-vitro antimicrobial activity of oleuropein and hydroxytyrosol. J Pharm Pharmacol. Aug1999;51(8):971-4.
  13. View Abstract: Bisignano G, et al. On the in-vitro antimicrobial activity of oleuropein and hydroxytyrosol. J Pharm Pharmacol. Aug1999;51(8):971-4.
  14. View Abstract: Visioli F. Antiatherogenic components of olive oil. Curr Atheroscler Rep. Jan2001;3(1):64-7.
  15. Renis HE. In vitro antiviral activity of calcium elenolate. Antimicrob. Agents Chemother. 1970;167-72.
  16. Heinze JE, et al. Specificity of the antiviral agent calcium elenolate. Antimicrob Agents Chemother. Oct1975;8(4):421-5.
  17. View Abstract: Bisignano G, et al. On the in-vitro antimicrobial activity of oleuropein and hydroxytyrosol. J Pharm Pharmacol. Aug1999;51(8):971-4.
  18. Ernst E. Cardioprotection and Garlic. Lancet. 1997;349(9045):131.
  19. View Abstract: Steiner M, et al. A Double-blind Crossover Study in Moderately Hypercholesterolemic Men that Compared the Effect of Aged Garlic Extract and Placebo Administration on Blood Lipids. Am J Clin Nutr. 1996;64(6):866-70.
  20. View Abstract: Adetumbi M, et al. Allium sativum (Garlic)--A Natural Antibiotic. Med Hypoth. 1983;12:227-37.
  21. View Abstract: Pai ST, et al. Antifungal Effects of Allium sativum (Garlic) Extract Against the Aspergillus Species Involved in Otomycosis. Lett Appl Microbiol. 1995;20(1):14-18.
  22. Altman PM. Australian tea tree oil. Australian J Pharmacy. 1988;69:276-78.
  23. Penfold AR, et al. Some notes on the Essential oil of M. alternifolia. Aust J Dent. 417-4181930.
  24. View Abstract: Mann CM, et al. The outer membrane of pseudomonas aeruginosa NCTC 6749 contributes to its tolerance to the essential oil of melaleuca alternifolia. Lett Appl Microbiol. Apr2000;30(4):294-7.
  25. Carson CF, et al. Efficacy and safety of tea tree oil as a topical antimicrobial agent. J Hosp Infect. Nov1998;40(3):175-8.
  26. View Abstract: Carson CF, et al. Susceptibility of methicillin-resistant Staphylococcus aureus to the essential oil of Melaleuca alternifolia. J Antimicrob Chemother. Mar1995;35(3):421-4.
  27. View Abstract: Nenoff P, et al. Antifungal activity of the essential oil of Melaleuca alternifolia (tea tree oil) against pathogenic fungi in vitro. Skin Pharmacol. 1996;9(6):388-94.
  28. View Abstract: Tong MM, et al. Tea tree oil in the treatment of tinea pedis. Australas J Dermatol. 1992;33(3):145-9.
  29. Ionescu G, et al. Oral Citrus seed extract. J Orthomolecula Med. 1990;5(3):72-74.
  30. Ionescu G, et al. Oral Citrus seed extract. J Orthomolecula Med. 1990;5(3):72-74.
  31. View Abstract: Hauer J, et al. Mechanism of Stimulation of Human Natural Killer Cytotoxicity by Arabinogalactan from Larix occidentalis. Cancer Immunol Immunother. 1993;36(4):237-44.